Tuesday, December 18, 2012

Some ideas for mental health reform

Since I've been very vocal recently about the need for reform in the mental health field, I think its time to float some ideas.

First, I think we need to work on identification of illness. Privacy, especially in health care, is an absolute necessity, but I believe that, in order for reform to happen, we need the ability to cross check between law enforcement and medical professionals. As an idea, we could create a framework by which medical records could be flagged for violent mental illness tendencies and cross-referenced with criminal records. This would also allow law enforcement access to a violent history. I'm thinking we use a double blind system, where doctors and cops could see the flags, but access to the actual records would be by court order only. This maintains the confidential nature of the medical records. If we based the criteria on flag-counting, we can minimize false positives, as well as minimizing systemic abuse (as in cops or shrinks flagging records without cause). After a certain number of flags are marked, a review board would be able to recommend to the court whether or not to unseal the records.

Next, we need to revamp access to durable care. It has been noted that the largest treatment centers for mental illness are actually contained inside the prison system. This indicates to me that there is little to no support system for treatment until after a criminal conviction.

*A cautionary note- previously, mental health care was the purview of institutions that were little more than dumping grounds for people that were too hard to deal with. The nature of their illness and the level of apathy involved transformed many of them into nightmares, where even basic care was denied. Upon committal, patients would remain, without treatment (except for experimental therapy such as lobotomy or electro-shock) until they died. Conditions were often abhorrent.*

We need to establish reliable long-term treatment centers specifically to treat mental illness. They need to be staffed with professionals and should offer rehabilitation services, such as skill training and employment services. I am picturing something akin to drug and alcohol rehab centers with a heavy mixture of group home settings and work release. Aside- manufacturing and skilled artisan jobs would be a good fit here. Both would provide for compensation, job skills, and pride of self, while not requiring a lot of public contact and allowing for easy pickup and dropoff of patients.

Third- any and all flags, judgements, and records need to have an expiration date. This is CRITICAL because it will help ease the stigma of diagnosis. We have every reason to believe that there are people that would otherwise have sought help if it were not for the permanent nature of the diagnosis. If any and all diagnosese are inactive for a period of, say, 5 years, they would be sealed and rendered inactive unless additional flags are noted.

So that's my start. It won't entirely fix the problem, but its a framework to address the shortcomings of our current system. Please, leave comments regarding amendments. Lets get moving on this.